The document discusses BI-RADS, a standardized system for breast imaging reporting and assessment. It provides standardized terminology (descriptors) for mammography, ultrasound, and MRI findings. All breast imaging reports should adhere closely to the BI-RADS lexicon and assessment categories to reduce confusion and facilitate outcome monitoring. The document also discusses different breast tissue compositions, common benign and suspicious findings on mammograms such as asymmetries and calcifications, and how these findings are classified and should be reported.

1. Dr. Mohit Goel
JRIII
27/2/15

2. BI-RADS® is designed to standardize breast imaging reporting and to
reduce confusion in breast imaging interpretations.
It also facilitates outcome monitoring and quality assessment.
It contains a lexicon for standardized terminology (descriptors) for
mammography, breast US and MRI.
All mammographic, ultrasound, and breast MRI findings and reports
should closely adhere to the BI-RADS lexicon and assessment
categories.

8. BIRADS

12. In BI-RADS 2013 the use of percentages is discouraged, because in individual cases it is more
important to take into account the chance that a mass can be obscured by fibroglandular tissue
than the percentage of breast density as an indicator for breast cancer risk.

14. The composition is c - heterogeneously dense, although the volume of fibroglandular tissue is
less than 50%.
The fibroglandular tissue in the upper part is sufficiently dense to obscure small masses.
So it is called c, because small masses can be obscured.
Historically this would have been called an ACR 2: 25-50% density.

15. Dense fibroglandular tissue have an increased risk of developing
breast cancer, and detection of early cancer can be obscured by the
fibroglandular tissue.
Bilateral interval increase in fibroglandular density is usually benign
and may be caused either by hormonal effects or breast edema.
A unilateral increase in fibroglandular density is worrisome for
lymphatic obstruction, which may be malignant.
Hormone therapy may cause an increase in fibroglandular density.
Pregnancy, lactation, and weight loss may all cause an interval
increase in fibroglandular density.

17. A mammographic mass is a space-occupying lesion with convex borders seen in
two different projections. In contrast, an asymmetry is seen in one view only.

23. Architectural distortionrepresents radiating linear densities emanating from a central
point, without a definite mass visible.

24. Asymmetry as an area of fibroglandulair tissue visible on only one mammographic
projection, mostly caused by superimposition of normal breast tissue

25. In the 2003 atlas calcifications were
classified by morphology and distribution
either as benign, intermediate concern or
high probability of malignancy.
In the 2013 version the approach has
changed.
Since calcifications of intermediate
concern and of high probability of
malignancy all are being treated the
same way, which usually means biopsy, it
is logic to group them together.
Calcifications are now either typically
benign or of suspicious morphology

27. Skin calcifications are associated with sweat glands, are usually punctate or lucent-centered,
and are most common medially, where the concentration of sweat glands is higher.

28. Arterial vascular calcifications are present in the upper portion of the image (yellow arrow),
while large rod-like calcifications are present in the inferior portion of the image (red arrows).
Arterial vascular calcifications within the breast have a distinctive morphology and are
typically not mentioned in the body of the report unless they are very extensive or the
patient is very young

40. highly suspicious for malignancy. The branching distribution suggests filling of the lumen of a
duct system involved by DCIS.

50. THANK YOU